Healthcare Provider Details

I. General information

NPI: 1649949348
Provider Name (Legal Business Name): MICHAEL S KAY LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 S 16TH ST
PHILADELPHIA PA
19102-4908
US

IV. Provider business mailing address

2932 MORRIS RD
ARDMORE PA
19003-1833
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-8244
  • Fax:
Mailing address:
  • Phone: 610-937-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW137298
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: